Endoscope control system

ABSTRACT

Control of the endoscope in a surgical system is described. In some embodiments, the endoscope can be controlled by movement of the surgeon&#39;s head or face at a surgeon&#39;s console. In some embodiments, the endoscope can be controlled using sensors integrated with a surgeon&#39;s headrest mounted on the surgeon&#39;s console.

TECHNICAL FIELD

Embodiments of the present invention are related to instrument control,and in particular to control of instruments used in minimally invasiverobotic surgery.

DISCUSSION OF RELATED ART

Surgical procedures can be performed through a surgical robot in aminimally invasive manner. The benefits of a minimally invasive surgeryare well known and include less patient trauma, less blood loss, andfaster recovery times when compared to traditional, open incisionsurgery. In addition, the use of robot surgical systems (e.g.,teleoperated robotic systems that provide telepresence), such as the daVinci™ Surgical System manufacture by Intuitive Surgical, Inc. ofSunnyvale, Calif., is known. Such robotic surgical systems may allow asurgeon to operate with intuitive control and increased precision whencompared to manual minimally invasive surgeries.

In a minimally invasive surgical system, surgery is performed by asurgeon controlling the robot. The robot includes one or moreinstruments that are coupled to robot arms. The instruments access thesurgical area through small incisions through the skin of the patient. Acannula is inserted into the incision and a shaft of the instrument canbe inserted through the cannula to access the surgical area. Anendoscope can be used to view the surgical area. In many cases, thesurgeon can control one instrument at a time. If the surgeon wants tochange the view of the endoscope, control is shifted from the currentsurgical instrument to the endoscope, the surgeon manipulates theendoscope, and control is shifted back to the surgical instrument.

Therefore, there is a need to develop better surgical systems forrobotic minimum invasive surgeries.

SUMMARY

In accordance with aspects of the present invention, movement of animage of the surgery can be controlled by motion of the surgeon's heador face at the surgeon's console. In some embodiments, for example, asurgeon's console includes an image display system that displays animage of a surgical area; and at least one sensor mounted in thesurgeon's console to provide a signal related to a movement of thesurgeon's face, the image being moved according to the signal.

In some embodiments, a headrest for a surgical console includes aforehead rest surface; a headrest mount that can attach to the surgicalconsole; and one or more sensors in the headrest that detect inputs froma surgeon's head and provides signals to an endoscope control.

In some embodiments, an endoscope control system includes endoscopecontrols that receive signals that indicate movement of a surgeon's headand provide an indication of movement of an image received by anendoscope; endoscope manipulation configured to receive the indicationof movement of an image and generate signals to affect movement of theendoscope to control the movement of the image; and actuators that canbe coupled to the endoscope, the actuators receive the signals to affectmovement and control the endoscope to provide the movement.

These and other embodiments are further discussed below with respect tothe following figures.

BRIEF DESCRIPTION OF THE DRAWINGS

FIGS. 1A, 1B, and 1C illustrate components of an example teleoperatedrobotic surgical system.

FIG. 2 illustrates cannulas as utilized by the system of FIGS. 1A, 1B,and 1C.

FIG. 3 illustrates an endoscope that can be utilized with someembodiments of the present invention.

FIG. 4A illustrates an imaging and control system according to someembodiments of the present invention.

FIG. 4B illustrate a process that can be executed to control anendoscope according to the present invention.

FIGS. 5A, 5B, 5C, 5D, and 5E illustrates a headrest.

FIGS. 6A, 6B, 6C, 6D, and 6E illustrate an embodiment of the headrestaccording to the present invention.

FIG. 7 illustrates another embodiment of the headrest according to thepresent invention.

FIG. 8 illustrates another embodiment of the headrest according to thepresent invention.

FIG. 9 illustrates another embodiment of the headrest according to thepresent invention.

FIG. 10 illustrates another embodiment of the headrest according to thepresent invention.

FIG. 11 illustrates an embodiment of the invention.

FIG. 12 illustrates another embodiment of the invention.

DETAILED DESCRIPTION

In the following description, specific details are set forth describingsome embodiments of the present invention. It will be apparent, however,to one skilled in the art that some embodiments may be practiced withoutsome or all of these specific details. The specific embodimentsdisclosed herein are meant to be illustrative but not limiting. Oneskilled in the art may realize other elements that, although notspecifically described here, are within the scope and the spirit of thisdisclosure.

This description and the accompanying drawings that illustrate inventiveaspects and embodiments should not be taken as limiting—the claimsdefine the protected invention. Various mechanical, compositional,structural, and operational changes may be made without departing fromthe spirit and scope of this description and the claims. In someinstances, well-known structures and techniques have not been shown ordescribed in detail in order not to obscure the invention.

Additionally, the drawings are not to scale. Relative sizes ofcomponents are for illustrative purposes only and do not reflect theactual sizes that may occur in any actual embodiment of the invention.Like numbers in two or more figures represent the same or similarelements.

Further, this description's terminology is not intended to limit theinvention. For example, spatially relative terms—such as “beneath”,“below”, “lower”, “above”, “upper”, “proximal”, “distal”, and thelike—may be used to describe one element's or feature's relationship toanother element or feature as illustrated in the figures. Thesespatially relative terms are intended to encompass different positions(i.e., locations) and orientations (i.e., rotational placements) of adevice in use or operation in addition to the position and orientationshown in the figures. For example, if a device in the figures is turnedover, elements described as “below” or “beneath” other elements orfeatures would then be “above” or “over” the other elements or features.Thus, the exemplary term “below” can encompass both positions andorientations of above and below. A device may be otherwise oriented(rotated 90 degrees or at other orientations) and the spatially relativedescriptors used herein interpreted accordingly. Likewise, descriptionsof movement along and around various axes includes various specialdevice positions and orientations. In addition, the singular forms “a”,“an”, and “the” are intended to include the plural forms as well, unlessthe context indicates otherwise. And, the terms “comprises”,“comprising”, “includes”, and the like specify the presence of statedfeatures, steps, operations, elements, and/or components but do notpreclude the presence or addition of one or more other features, steps,operations, elements, components, and/or groups. Components described ascoupled may be electrically or mechanically directly coupled, or theymay be indirectly coupled via one or more intermediate components.

Elements and their associated aspects that are described in detail withreference to one embodiment may, whenever practical, be included inother embodiments in which they are not specifically shown or described.For example, if an element is described in detail with reference to oneembodiment and is not described with reference to a second embodiment,the element may nevertheless be claimed as included in the secondembodiment.

Aspects of embodiments of the invention are described within the contextof a particular implementation of a robotic surgical system.Knowledgeable persons will understand, however, that inventive aspectsdisclosed herein may be embodied and implemented in various ways,including robotic and non-robotic embodiments and implementations. Theimplementations disclosed here are merely exemplary and are not to beconsidered as limiting the scope of the inventive aspects disclosedherein.

FIGS. 1A, 1B, and 1C are front elevation views of three main componentsof a teleoperated robotic surgical system for minimally invasivesurgery. These three components are interconnected so as to allow asurgeon, with the assistance of a surgical team, to perform diagnosticand corrective surgical procedures on a patient.

FIG. 1A is a front elevation view of the patient side cart component 100of, for example, the da Vinci™ Surgical System. The patient side cartincludes a base 102 that rests on the floor, a support tower 104 that ismounted on the base 102, and several arms that support surgical tools.As shown in FIG. 1A, arms 106 a, 106 b, and 106 c are instrument armsthat support and move the surgical instruments used to manipulatetissue. Arm 108, for example, can be a camera arm that supports andmoves an endoscope instrument 112. Instrument arm 106 c can be anoptional third instrument arm that is supported on the back side ofsupport tower 104 and that can be positioned to either the left or rightside of the patient side cart as necessary to conduct a surgicalprocedure. FIG. 1A further shows interchangeable surgical instruments110 a,110 b,110 c mounted on the instrument arms 106 a,106 b,106 c, andit shows endoscope 112 mounted on the camera arm 108. Knowledgeablepersons will appreciate that the arms that support the instruments andthe camera may also be supported by a base platform (fixed or moveable)mounted to a ceiling or wall, or in some instances to another piece ofequipment in the operating room (e.g., the operating table). Likewise,they will appreciate that two or more separate bases may be used (e.g.,one base supporting each arm).

As is further illustrated in FIG. 1A, instruments 110 a, 110 b, 110 c,and endoscope 112 include an instrument interface 150 a, 150 b, 150 c,and 150 d, respectively, and an instrument shaft 152 a, 152 b, 152 c,and 152 d, respectively. In some embodiments, component 100 can includesupports for cannulas that fix instruments 110 a, 110 b, 110 c, andendoscope 112 with respect to the cannulas.

Further, portions of each of the instrument arms 106 a, 106 b, 106 c,and 108 are adjustable by personnel in the operating room in order toposition instruments 110 a, 110 b, 110 c, and endoscope 112 with respectto a patient. Other portions of arms 106 a, 106 b, 106 c, and 108 areactuated and controlled by the surgeon at a surgeon's console 120.Surgical instruments 110 a, 110 b, 110 c, and endoscope 112, can also becontrolled by the surgeon at surgeon's console 120.

FIG. 1B is a front elevation view of a surgeon's console 120 componentof an example surgical system. The surgeon's console 120 is equippedwith left and right multiple degree-of-freedom (DOF) master toolmanipulators (MTM's) 122 a, 122 b, which are kinematic chains that areused to control the surgical tools. The surgeon grasps a pincherassembly 124 a, 124 b on each MTM 122, typically with the thumb andforefinger, and can move the pincher assembly to various positions andorientations. When a tool control mode is selected, each MTM 122 iscoupled to control a corresponding instrument and instrument arm 106 forthe patient side cart 100. For example, left MTM 122 a may be coupled tocontrol instrument arm 106 b and instrument 110 a, and right MTM 122 bmay be coupled to control instrument arm 106 b and instrument 110 b. Ifthe third instrument arm 106 c is used during a surgical procedure andis positioned on the left side, then left MTM 122 a can be switchedbetween controlling arm 106 a and instrument 110 a to controlling arm106 c and instrument 110 c. Likewise, if the third instrument arm 106 cis used during a surgical procedure and is positioned on the right side,then right MTM 122 a can be switched between controlling arm 106 b andinstrument 110 b to controlling arm 106 c and instrument 110 c. In someinstances, control assignments between MTM's 122 a, 122 b and arm 106a/instrument 110 a combination and arm 106 b/instrument 110 bcombination may also be exchanged. This may be done, for example, if theendoscope is rolled 180 degrees, so that the instrument moving in theendoscope's field of view appears to be on the same side as the MTM thesurgeon is moving. The pincher assembly is typically used to operate ajawed surgical end effector (e.g., scissors, grasping retractor, needledriver, and the like) at the distal end of an instrument 110.

Additional controls are provided with foot pedals 128. Each of footpedals 128 can activate certain functionality on the selected one ofinstruments 110. For example, foot pedals 128 can activate a drill or acautery tool or may operate irrigation, suction, or other functions.Multiple instruments can be activated by depressing multiple ones ofpedals 128. Certain functionality of instruments 110 may be activated byother controls.

Surgeon's console 120 also includes a stereoscopic image display 126.Left side and right side images captured by the stereoscopic endoscope112 are output on corresponding left and right displays, which thesurgeon perceives as a three-dimensional image on display system 126. Inan advantageous configuration, the MTMs 122 are positioned below displaysystem 126 so that the images of the surgical tools shown in the displayappear to be co-located with the surgeon's hands below the display. Thisfeature allows the surgeon to intuitively control the various surgicaltools in the three-dimensional display as if watching the handsdirectly. Accordingly, the MTM servo control of the associatedinstrument arm and instrument is based on the endoscopic image referenceframe.

The endoscopic image reference frame is also used if the MTM's 122 areswitched to a camera control mode. In some cases, if the camera controlmode is selected, the surgeon may move the distal end of the endoscope112 by moving one or both of the MTM's 122 together (portions of the twoMTM's 122 may be servomechanically coupled so that the two MTM portionsappear to move together as a unit). The surgeon may then intuitivelymove (e.g., pan, tilt, zoom) the displayed stereoscopic image by movingthe MTM's 122 as if holding the image in the hands.

As is further shown in FIG. 1B, a headrest 130 is positioned abovedisplay system 126. As the surgeon is looking through display system126, the surgeon's forehead is positioned against headrest 130. In someembodiments of the present invention, manipulation of endoscope 112 orother instruments can be achieved through manipulation of headrest 130instead of utilization of MTM's 122. In some embodiments, headrest 130can, for example, include pressure sensors, a rocker plate, opticallymonitored slip plate, or other sensors that can detect movement of thesurgeon's head. As such, headrest 130 includes a device that monitorsand tracks motion of the surgeon's head. In each of these cases, thedata indicating the motion of the surgeon's head can be used tomanipulate endoscope 112 in order to change the image displayed ondisplay system 126.

The surgeon's console 120 is typically located in the same operatingroom as the patient side cart 100, although it is positioned so that thesurgeon operating the console is outside the sterile field. One or moreassistants typically assist the surgeon by working within the sterilesurgical field (e.g., to change tools on patient side cart 100, toperform manual retraction, etc.). Accordingly, the surgeon operatesremote from the sterile field, and so the console may be located in aseparate room or building from the operating room. In someimplementations, two consoles 120 (either co-located or remote from oneanother) may be networked together so that two surgeons cansimultaneously view and control tools at the surgical site.

FIG. 1C is a front elevation view of a vision cart component 140 of asurgical system. The vision cart 140 can, for example, house thesurgical system's central electronic data processing unit 142 and visionequipment 144. The central electronic data processing unit includes muchof the data processing used to operate the surgical system. In variousother implementations, however, the electronic data processing may bedistributed in the surgeon console 120 and patient side cart 100. Thevision equipment includes camera control units for the left and rightimage capture functions of the stereoscopic endoscope 112. The visionequipment also includes illumination equipment (e.g., Xenon lamp) thatprovides illumination for imaging the surgical site. As shown in FIG.1C, the vision cart includes an optional touch screen monitor 146 (forexample a 24-inch monitor), which may be mounted elsewhere, such as onthe patient side cart 100. The vision cart 140 further includes space148 for optional auxiliary surgical equipment, such as electrosurgicalunits, insufflators, suction irrigation instruments, or third-partycautery equipment. The patient side cart 100 and the surgeon's console120 are coupled, for example via optical fiber communications links, tothe vision cart 140 so that the three components together act as asingle teleoperated minimally invasive surgical system that provides anintuitive telepresence for the surgeon. And, as mentioned above, asecond surgeon's console may be included so that a second surgeon can,e.g., proctor the first surgeon's work.

During a typical surgical procedure with the robotic surgical systemdescribed with reference to FIGS. 1A-1C, at least two incisions are madeinto the patient's body (usually with the use of a trocar to place theassociated cannula). One incision is for the endoscope camerainstrument, and the other incisions are for the surgical instruments. Insome surgical procedures, several instrument and/or camera ports areutilized to provide access and imaging for a surgical site. Although theincisions are relatively small in comparison to larger incisions usedfor traditional open surgery, a minimum number of incisions is desiredto further reduce patient trauma and for improved cosmesis.

FIG. 2 illustrates utilization of the surgical instruments illustratedin FIGS. 1A, 1B, and 1C. As shown in FIG. 2, shafts 152 a, 152 b, and152 d pass through cannulas 202 a, 202 b, and 202 d, respectively.Cannulas 202 a, 202 b, and 202 d extend through instrument incisions 204a, 204 b, and 204 d, respectively. As is shown in FIG. 2, shafts 152 a,152 b, and 152 d extend through cannulas 202 a, 202 b, and 202 d,respectively. End effectors 206 a, 206 b, and 206 d are attached toshafts 152 a, 152 b, and 152 d, respectively. As discussed above, endeffectors 206 a, and 206 b can be jawed surgical end effectors (e.g.,scissors, grasping retractor, needle driver, and the like). Further, endeffector 206 c is illustrated as an endoscope tip. As shown in FIG. 2,cannulas 202 a, 202 b, and 202 d and shafts 152 a, 152 b, and 152 d arepositioned so that end effectors 206 a, 206 b, and 206 d operate in asurgical area 210.

As shown in FIG. 2 cannulas 202 a, 202 b, and 202 d include mountingfittings 208 a, 208 b, and 208 d, respectively, that can be engaged byarms 106 a, 106 b, and endoscope arm 108, respectively, to allow forvery little movement of the instrument end effectors 206 a, 206 b, and206 d, respectively, as possible. Cannulas 202 a, 202 b, and 202 dfurther include cannula seal mounts 212 a, 212 b, and 212 d,respectively.

During surgery, particularly if the surgery is abdominal surgery,pressurized CO₂ can be utilized to expand the abdomen, allowing forbetter access to surgical area 210. Cannula seals attached to cannulaseal mounts 212 a, 212 b, and 212 d prevent leakage of fluids or othermaterials from the patient.

During the operation, the surgeon sitting at surgeon's console 120 canmanipulate end effectors 206 a, 206 b, and 206 d as well as move shafts152 a, 152 b, and 152 d along their lengths. In the particulararrangement illustrated in FIG. 2, instrument 206 d is illustrated as anendoscope, instrument 206 a can be, for example, a cautery tool, andinstrument 206 b can be, for example, a suction irrigator tool. Whilethe surgeon needs to control instruments 206 a and 206 d with the MTMs122, it is difficult to further control the endoscopic camera ofinstrument 112. Therefore, some embodiments of the present inventionprovide another control mechanism in order to allow the surgeon to usesensors on a headrest to control endoscopic camera instrument 112 whilecontinuing to manipulate MTMs 122 to control surgical instruments 206 aand 206 b.

According to some embodiments of the invention, a sensing method allowsfor the surgeon to manipulate the headrest in order to control, forexample, the endoscopic camera while separately using MTMs 122 tocontrol the surgical instruments. Some embodiments of the presentinvention can eliminate the need to switch modes from instrument controlto camera control, and then back again, when it is necessary toreposition the camera. In some embodiments, positioning the camera orcontrol of the camera zoom level can be accomplished while the surgicalinstruments are actively being controlled by the surgeon.

As shown in FIG. 2, endoscope 112 includes shaft 152 d that passesthrough cannula 202 d. End effector 206 d at the distal end of shaft 152d can include optics and mechanics to illuminate surgical area 210 andcapture an image, in some cases a stereo image, of surgical area 210.Although FIGS. 1A, 1B, 1C and 2 illustrate, for example, a multi-portrobotic surgical system, embodiments of the present invention can alsobe used in a single-port robotic surgical system. In general,embodiments of the present invention can be used with any roboticsurgical system where the surgeon is controlling instruments from aremote panel.

FIG. 3 illustrates endoscope 112 in further detail. As shown in FIG. 3,endoscope 112 includes end effector 206 d at the distal end, whichincludes optics for lighting surgical area 210 and for capturing animage, for example a stereo image, from surgical area 210. End effector206 d can be coupled to a wrist 312 that is connected to shaft 310.Wrist 312 allows for movement of end effector 206 d in two degrees offreedom and may be controlled with cables or rods 310 that pass throughshaft 310. In some embodiments, some axial movement of end effector 206d can also be controlled by cables or rods 310. Optical fiber (notshown) may also pass through shaft 152 d and be coupled to the optics inend effector 206 d to both provide light and to transmit the image.

Shaft 152 d is connected to instrument interface 150 d. Instrumentinterface 150 d, as shown in FIG. 1A, can be coupled to arm 108 ofpatient side cart 100. In some embodiments, interface 150 d couplesactuation motors in arm 108 with cables and rods 310 in shaft 152 d.Instrument interface 150 d includes, then, mechanisms that can be drivenby an actuation motor that affect wrist 312 and end effector 206 d. Arm108 can be actuated to provide movement of endoscope 112 along the axisof shaft 152 d.

In practice, the optics in end effector 206 d can include an ability tozoom the image into or out of surgical area 210. Further, instrumentinterface 150 d or instrument arm 106 d has the ability to moveendoscope 112 laterally along the axis of shaft 152 d, thereby providinga zoom function. Whether a zoom feature in end effector 206 d ormovement of shaft 152 d is used to zoom on an image can be controlled bysoftware operating in the surgical system. End effector 206 d can alsobe moved within a spherical surface by manipulating wrist 312. Movementof end effector 206 d with wrist 312 can be used to provide differentimages of surgical area 210.

FIG. 4A illustrates the control system for an embodiment of endoscope112 such as that shown in FIG. 3. As shown in FIG. 4A, endoscopecontrols 402 provide control signals to endoscope manipulationcalculation 404. Endoscope controls 402 can be controls according tosome embodiments of the present invention, as described below, or may beinput signals from MTMs 122 as described above.

Endoscope controls 402 may include processing capability to receivesignals from one or more sensors and determine from those signals whatthe surgeon intends for the change in the image. For example, endoscopecontrols 402 can determine whether the surgeon requests a zoom functionor whether the surgeon requests that the image be panned and in whichdirection the image should be panned. As such, endoscope controls 402may include one or more processors coupled with memory (volatile,nonvolatile, or a combination) to hold data and programminginstructions. The programming instructions may include instructions totranslate signals received from the one or more sensors into signalsthat represent the requested action of the image produced by endoscope112.

Endoscope manipulation calculation 404 provides signals to actuators406. Actuators 406 are mechanically coupled to instrument interface 150d on endoscope 112. Therefore, endoscope manipulation calculation 404translates the signals received from endoscope controls 402 into actionsperformed by actuators 406 that result in the corresponding motion ofend effector 206 d of endoscope 112. As discussed above, the motion ofend effector 206 d can be axial in end effector 206 d (zooming endeffector 206 d using internal optics or by movement of end effector 206d along its axis), can be lateral by movement of wrist 312 which resultsin movement of the tip of end effector 206 d along a substantiallyspherical surface, or can result in axial motion of endoscope 112 alongthe axis of shaft 152 d. Zoom and image adjustments can be performed bycombinations of various motions that are communicated through instrumentinterface 150 d.

Endoscope manipulation calculation 404 can include a processor executinginstructions that calculate the motions that actuators 406 perform inorder to result in the motion according to the surgeon input atendoscope controls 402. As discussed above with respect to endoscopecontrols 402, endoscope manipulation calculation 404 can include one ormore processors coupled to memories (volatile, nonvolatile, or acombination) that hold data and programming. In some embodiments,endoscope controls 402 and endoscope manipulation calculation 404 can beperformed by the same processors executing the appropriate programinstructions.

In some cases, endoscope controls 402 can include MTMs 122. Inaccordance with some embodiments of the present invention, endoscopecontrols 402 can include sensors in headrest 130 and can be controlledby the surgeon's motion of his head on headrest 130. Endoscope controls402 included in headrest 130 are discussed in further detail below. Insome embodiments, endoscope controls 402 can include sensors positionedon surgeon's console 120 that track the motion of the surgeon's head.

Endoscope manipulation calculation 404 provides signals to operateactuators 406. Actuators 406 are generally rotary motors housed inpatient side cart 100 arm 108, on which endoscope 112 is attached, anddrive interface 150 d and arm 108. As discussed above, instrumentinterface 150 d translates the mechanical inputs of actuators 406 intomovement of wrist 312 and end effector 206 d.

Endoscope controls 402 can also control the light output of illumination410. Illumination 410 provides light through optical fiber in endoscope112 in order to illuminate surgical area 210 (FIG. 2). An image ofsurgical area 210 is captured by end effector 206 d and transported byoptical fiber to image capture and processing 408. Image capture andprocessing 408 digitizes the image captured by end effector 206 d andprovides that image to display 126 on surgeon's console 120 (FIG. 1B).

As illustrated in FIG. 4A, the surgeon controls the positioning of endeffector 206 d through endoscope controls 402. Endoscope controls 402can include MTMs 122 in an endoscope manipulation mode. In accordancewith some embodiments of the present invention, endoscope controls 402can include input from sensors embedded in headrest 130 or other sensorspositioned on surgical console 120.

FIG. 4B illustrates a procedure 450 according to some embodiments thatcan be performed between endoscope controls 402 and endoscopemanipulation 404. As shown in FIG. 4B, in step 452 endoscope controls402 receives signals from one or more sensors mounted on surgeon'sconsole 120. In some embodiments, the sensors are integrated withheadrest 130. In some embodiments, the sensors are integrated withsurgeon's console 120. The sensors detect a surgeon's input respectingcontrol of endoscope 112. For example, the sensors can provide signalsrelated to the surgeon's head movement or eye movement.

In step 454, the action requested by the surgeon is determined byendoscope controls 402 based on the signals from the one or moresensors. Such actions can include panning the image generated byendoscope 112 or zooming in or out of the image generated by endoscope112. For example, a detected rotation of the surgeon's face to the rightmay be interpreted as a request to pan the image to the right while amovement of the surgeon's face into console 120 may be interpreted as arequest to zoom into the image.

In step 456, the action requested by the surgeon determined in step 454is translated to input actuation signals for actuators 406 that driveendoscope 112 and robot arm 108 to perform the requested action. Forexample, a zoom request may result in signals that drive robot arm 108or to zoom with the optics in end effector 206 d. A pan request resultsin activation of wrist 312 in the appropriate direction throughinterface 150 d. In step 458, the actuation signals are applied toactuators 406 to perform the requested action.

FIGS. 5A through 5E illustrate an example of a headrest 130 that can beattached to the surgeon console 120. The example of headrest 130 shownin FIGS. 5A through 5E are presented for illustration only and are notmeant to be limiting. One skilled in the art will recognize that aheadrest can take a variety of shapes, any of which can be usedaccording to some embodiments of the present invention.

In some cases, headrest 130 can be molded out of foam and covered with,for example a vinyl covering, for both decoration and functionality.FIG. 5A illustrates a generally frontal view of headrest 130. As shownin FIG. 5A, a forehead rest 502 is formed against which a surgeon'sforehead can rest while viewing an image of surgical area 210 throughdisplay 126. In some cases, speaker grills 506 can be formed in an upperportion 504 above forehead rest 502 to allow sound from speakers mountedbehind speaker grills 506 to reach the surgeon. A curved front 510 canbe formed below forehead rest 502. A mounting portion 508 can be formedintegral with upper portion 504 and forehead rest 502. FIG. 5Billustrate a view of headrest 130 that further shows speaker grills 506and forehead rest 502.

FIG. 5C illustrates a side view of an example headrest 130. As shown inFIG. 5C, mounting portion 508 can be shaped to facilitate mounting onsurgeon's console 120. In the example illustrated in FIG. 5C, mountingportion 508 includes side surface 516, back surface 518, upper backsurface 528, and bottom surfaces 514 and 512 that serve to position andsupport headrest 130 against surgeon's console 120.

FIGS. 5D and 5E provide further views of headrest 130. FIG. 5D showsgenerally a frontal view with a showing of rounded surface 512 andbottom surface 514. As shown in FIG. 5D, two angled surfaces 520 can beformed adjacent to bottom surface 514. FIG. 5E illustrates a moredetailed bottom view of headrest 130, where surface 512 is adjacentangle surfaces 522.

The shape of mounting portion 508 is dependent on the mounting ofheadrest 130 onto surgeon's console 120. As such, the shape of mountingportion 508 can be as varied as the number of mounting configurationsthat can be used for attaching headrest 130 onto surgeon's console 120.

In accordance with some embodiments of the present invention, sensorsare embedded within or on headrest 130 to allow the surgeon to provideinput signals for endoscope controls 420 by motion of the surgeon'shead. In some embodiments, for example, a pressure sensor array can beembedded in headrest 130. The pressure sensor array can sense pressurethat the surgeon applies to areas of the front surface of forehead rest502. The pressure data from the pressure sensor array can then beconverted into endoscope control data. In some embodiments, a rockerplate can be inserted into headrest 130. The rocker plate can operate,for example, similarly to a joystick so that endoscope control data canbe obtained by the motion of the surgeon's head against the frontsurface of forehead rest 502. In some embodiments, an opticalarrangement can be provided to read the movement of a slip plate mountedon headrest 130. The motion of the slip plate is controlled by thesurgeon's head motion and can be converted to control data.

In some further embodiments, a face tracker system can be mounted onheadrest 130 or directly on surgeon's console 120. The face tracker canbe used to track the motion of the surgeon's face and convert thatmotion to endoscope control data. In some embodiments, an iris trackersystem can be included in display 126 that can be used to track themotion of the surgeon's eyes. Depending on the type of viewer in display126, the iris tracker sensors can be included in the optics or, if theviewer is a video screen, can be mounted on headrest 130 or on surgeon'sconsole 120 so as to track the motion of the surgeon's eyes and convertthat motion to endoscope control data.

Some embodiments of the current invention include endoscope controls 402attached to or within headrest 130. Endoscope controls 402 includesensing techniques that can control some or all of the position and zoomlevel (optically or digitally) of an endoscope 112 in a surgical roboticsystem. In some embodiments, the sensing techniques can capture a sensorsignature in two-dimensions to determine the direction of cameramovement, and in a third dimension to control the zoom (in/out motion)of the endoscope camera. As such, embodiments of the present inventionprovide an alternative mode for the surgeon to enter where the endoscopecamera is actively controlled simultaneously with the surgicalinstruments. Many of these systems are further discussed below. In some,a sensor input device is mounted into or onto headrest 130 in order totrack the surgeons head motions. The head motion signals are thenconverted to endoscope control signals in endoscope controls 402 asshown in FIG. 4.

FIGS. 6A, 6B, and 6C illustrate placement of a pressure sensor array 602in headrest 130. As shown in FIG. 6B, pressure sensor array 602 can beinserted into headrest 130 in close proximity to forehead rest 502 suchthat the surgeon can provide pressure inputs to areas of the surface offorehead rest 502 by moving the surgeon's forehead. FIG. 6C, forexample, illustrates an example of sensor array 602. As shown in FIG.6C, sensor array 602 can include a two dimensional array of sensorsmounted on a planar circuit board or backplane 620. FIG. 6C shows anexample with pressure sensors 612, 614, 616, and 618, although pressuresensor array 602 can include any number of pressure sensors mounted onplanar backplane 620.

As illustrated in FIG. 6B, pressure sensor array 602 can be positionedsubstantially parallel with the surface of forehead rest 502. In someembodiments, pressure sensor array 602 can be contoured to follow theshape of forehead rest 502. Further, pressure sensor array 602 can beprovided with a support (not shown) that prevents motion relative tosurgeon's console 120. Such support can, for example, be studs thatextend from pressure sensor array to attach to or contact withsturgeon's console 120.

As shown in FIG. 6A the surface of forehead rest 502 is petitioned intoareas according to the placement of individual pressure sensors inpressure sensor array 602 located beneath the surface of forehead rest502. In the particular example of pressure sensor array 602 with fourpressure sensors illustrated in FIG. 6C, the surface of forehead rest502 is partitioned into four areas where one pressure sensor is placedbeneath each of the areas. As illustrated, for example, area 604corresponds to pressure sensor 612, area 606 corresponds to pressuresensor 614, area 608 corresponds to pressure sensor 616, and area 610corresponds to pressure sensor 618. In other words, pressures sensor 612senses the pressure applied to area 604, pressure sensor 614 senses thepressure applied to area 606, pressure sensor 616 senses the pressureapplied to area 608, and pressures sensor 618 senses the pressureapplied to area 610. Pressure applied to areas 604 through 610 andsensed by pressure sensors 612 through 618, respectively, can be used toprovide signals for endoscope controls 402.

Pressure sensing array 602 is integrated into headrest 130, which ismounted on surgeon's console 120, within the foam under forehead rest502, where the surgeon rests his/her forehead. Surgeon's console canthen be electrically coupled to pressure sensing array 602 to record thepressure signature of the surgeon's forehead against forehead rest 502.As shown in FIG. 6A, this signature can be divided into multiple regions(areas 604 through 610 are illustrated in FIG. 6A) to determine thedirection of camera motion indicated by the surgeon's motion.

For example, to move end effector 206 d of end effector 112 such thatthe image viewed at display 126 is moved to the right, the surgeon can,for example, roll their head slightly to the left to create a pressureprofile with larger magnitudes in the left hand side of the array. Thepressure profile for this example is illustrated in FIG. 6D. As shown inFIG. 6D, pressure sensors 612 and 614 measure increased pressure inareas 604 and 606. In response to the data shown in FIG. 6D, endeffector 112 can be manipulated to move the image to the right.Alternatively, a surgeon's head roll to the left in some embodiments mayresult in movement of the image to the left.

In some embodiments, the velocity of the image movement can be aconstant, which may be set by a surgeon input elsewhere on surgeon'sconsole 120. In some embodiments, the velocity of the image movement canvary based on the magnitude of the forces within the signature as shownin FIG. 6D. In some embodiments, the speed of motion of the image can beaudibly indicated to the surgeon. For example, the speed of motion ofthe image can be indicated with audible clicks whose frequency indicatesthe speed of motion. In some embodiments, for example, the speed ofmotion can be indicated by volume or frequency of a tone.

In addition to audible feedback, visual feedback and haptic feedback, orother feedback mechanisms can be used to communicate information to thesurgeon. Visual feedback, for example, can be provided to the surgeonthrough display system 126 and may, for example, be a flashing lightwith frequency indicating the speed of motion or may be color coded sothat different colors indicate different speeds. Additionally, hapticfeedback may be included in headrest 130. For example, through hapticfeedback in headrest 130 a vibration, the frequency of which indicatesthe speed, is transmitted to the surgeon.

In some embodiments, a pressure profile indicating force perpendicularto the surgeon's forehead can indicate a request in/out motion of theendoscope 112 (motion along the endoscope shaft 152 d), or to controlthe level of zoom. For example, as illustrated in FIG. 6E a linearrelationship between the magnitude of the force perpendicular to theforehead rest 502 and the zoom level can be established. In thatexample, when the surgeon is operating in this control mode the surgeoncan affect a zoom by pressing their forehead a little harder against theforehead rest 502 to zoom in and let up on the pressure to zoom out. Theslope of this relationship, controlling the rate of zoom adjustment, canbe a parameter that the user sets via the surgeon console touchpad orvision cart touch panel interface.

In some embodiments, surgeon headrest 130 can include detectors, forexample proximity detectors, that determine the location of thesurgeon's head from a fixed point. The fixed point can, for example,represent the tip of the endoscope camera (i.e. the tip of end effector206 d). Movement in the surgeon's head can then control endoscopemotion, including image location and zoom. FIG. 7 illustrates anembodiment of headrest 130 that includes one or more sensors 702embedded under the surface of forehead rest 502 that collectively candetermine the position and orientation of the surgeon's foreheadrelative to the fixed point.

As discussed above, sensors 702 can be coupled to provide signals foranalysis in endoscope controls 402. Endoscope controls 402 then candetermine the location and/or the orientation of the surgeon's forehead.There may be any number of sensors 702. Sensors 702 can, for example, beproximity sensors that measure the distance to the surgeon's forehead.For example, a single centered proximity sensor can be used as a zoomcontrol, moving the camera in and out as the surgeon's forehead movescloser and further from forehead rest 502. Other sensors can be used todetermine side-to-side or up-and-down motions of the surgeon's forehead.Therefore, as the surgeon's head moves, the distance from the fixedpoint defined by the collection of sensors 702 is measured, and used asan input to control the camera. The perpendicular distance from thefixed point could be used to create a relationship between the zoomlevel and the distance from the fixed point to actively control thezoom. For example, as the surgeon's head rolls to the left, sensors 702on the left of forehead rest 502 may measure closer distances andsensors 702 on the right of forehead rest 502 may measure fartherdistances. This data can be used in endoscope controls 402 to indicatethat the surgeon has rolled his head to the left and endoscope 112 canbe controlled accordingly.

FIG. 8 illustrates an embodiment where headrest 130 is mounted to acontroller 800 that can be similar to a joystick. In the example ofjoystick controller 800 shown in FIG. 8, controller 800 can include afirst plate 802 that is fixed to headrest 103, for example oppositeforehead rest 502. First plate 802 can include a ball 806 fixed to firstplate 802. A sensor plate 804 can include a recess to receive ball 806and sensors that determine the rotational orientation of ball 806 withinthe recess of sensor plate 804. In some embodiments, ball 806 can bereplaced with a rod that is coupled to a receiver in sensor plate 804.As is further shown, springs 806 can be inserted between first plate 802and sensor plate 804 to provide tension that biases headrest 103 towarda neutral position. In some embodiments, sensor plate 804 can detectadditional pressure along a normal direction to sensor plate 804.Two-dimensional motion of the camera can therefore be controlled byrolling first plate 802 in a particular direction to cause endoscope 112to move the image in a corresponding direction. Pressure along thenormal direction can be used to activate motion of the camera throughheadrest 130 or can be used to control zoom of the camera of endoscope112.

FIG. 9 illustrates another embodiment of headrest 130. As shown in FIG.9, headrest 130 can be connected to a slip plate 901, which is allowedto slide in two dimensions with respect to surgeon's console 120. Adetector plate 902 can be fixed on surgeon's console 120 so that slipplate 901 moves with respect to detector plate 902. Detector plate 902can include, for example, an optical detector similar to an opticalmouse that monitors movement of slip plate 901. Movement of thesurgeon's head then causes slip plate 901 to move relative to detectorplate 902, resulting in a signal that can be used in endoscope controls402 to control endoscope 112. For example, optical tracker 904, whichmay include an optical source 906 and optical detector 908 pair,provides a signal that indicates the motion of slip plate 901 relativeto detector plate 902. Motion of slip plate 901 indicating left or rightmotion of the surgeon's head can provide signals in endoscope controls402 to move the image from endoscope 112 left or right and motion of thesurgeon's head up or down can provide signals to endoscope controls 402to move the image from endoscope 112 up or down.

In some embodiments, face tracking can be used to track the surgeon'sfacial orientation and determine when and how the surgeon's face moves.FIG. 10 illustrates a headrest 130 according to some embodiments of thepresent invention that includes a camera 1002 that can be used in facetracking software. Camera 1002 can provide images to endoscope controls402, which can analyze the images to perform face tracking. Therefore,endoscope controls 402 perform face tracking to determine theorientation of the surgeon's face relative to the surgeon's console 120.Movement of the face can then be used to control movement of endoscope112. Zoom, for example, can be controlled by the movement of thesurgeon's face perpendicular to camera 1002 (or in a direction away fromheadrest 130) while rotation of the surgeon's face in the plane headrest130 can be used to control the planar motion of endoscope 112.

FIG. 11 illustrates another embodiment that uses face tracking to trackthe surgeon's facial orientation and determine when and how thesurgeon's face moves. As shown in FIG. 12, at least one camera 1102 ismounted on surgeon's console below headrest 130 and in proximity toimage display 126. Camera 1102 can then provide an image of thesurgeon's face that can be analyzed in endoscope controls 402 asdescribed above.

In some embodiments, an iris tracking system can be utilized. FIG. 12illustrates iris tracking in surgeon's console 120. As shown in FIG. 12,iris tracking 1202 provides an optical tracking beam, which may be an IRbeam, that is optically combined in combiner 1214 with image 1212. Thecombined image is then incident on the surgeon's eye through the righteyepiece 1206. A similar optical arrangement can combine opticaltracking beam from iris tracker 1204 with image 1210 which is incidenton the surgeon's eye through the left eyepiece 1308. Iris trackers 1202and 1204 can receive the reflected tracking beam. Signals from iristrackers 1204 and 1202, which are related to movement of the surgeon'seyes, can then be provided to endoscope controls 402. The surgeon canthen request an image pan by moving the surgeon's eyes to the area to becentered in the image.

To address the safety concern of accidently moving the camera such thatthe instruments are outside the field of view the implementation couldconstrain the camera motion to a predefined region. The control strategycould also integrate tool tracking techniques to allow arbitrary cameramotion as long as the instrument tips stay with the field of view. Tooltracking could also be used to ensure that the camera does not collidewith the surgical instruments during motion.

In some embodiments, a clutching mechanism may also be included. Forexample, embodiments of the present invention may be activated with afoot pedal or by a particular motion of the head. Further, to avoidunintended movement, in some embodiments only particularly large motionsmay result in active control of endoscope 112.

The above detailed description is provided to illustrate specificembodiments of the present invention and is not intended to be limiting.Numerous variations and modifications within the scope of the presentinvention are possible. The present invention is set forth in thefollowing claims.

1. A surgeon's console, comprising: an image display system thatdisplays an image of a surgical area; and one or more sensors mounted inthe surgeon's console to provide a signal related to a movement of asurgeon's face, the image being moved according to the signal. 2.(canceled)
 3. The console of claim 1, wherein the one or more sensorsincludes at least one of an iris tracking sensor that tracks motion ofthe surgeon's eyes in a display, an array of pressure sensors mounted toa headrest a joystick control mounted in the headrest, a slip platemounted in the headrest, and one or more cameras that image thesurgeon's face. 4-8. (canceled)
 9. The console of claim 1, wherein aspeed that the image is moved is indicated to a surgeon.
 10. A headrestfor a surgical console, comprising: a forehead rest surface; a headrestmount configured to attach to the surgical console; and one or moresensors in the headrest that detect inputs from a surgeon's head andprovide signals based on the inputs to an endoscope control.
 11. Theheadrest of claim 10, wherein the one or more sensors include pressuresensors arranged as a pressure sensor array positioned adjacent theforehead rest surface, each of the pressure sensors corresponding to anarea of the forehead rest surface, pressure applied by the surgeon toone or more areas of the forehead rest surface providing input to thepressure sensor array to generate the signals.
 12. (canceled)
 13. Theheadrest of claim 11, wherein the endoscope control determines anendoscope action based on the signals.
 14. The headrest of claim 13,wherein the endoscope control is configured to cause a zoom of an imageprovided by the endoscope in response to pressure at the center of theforehead rest surface and to cause a pan of the image provided by theendoscope in response to pressure at an area of the forehead restsurface other than the center.
 15. (canceled)
 16. The headrest of claim14, wherein a speed of the pan is indicated to the surgeon.
 17. Theheadrest of claim 10, wherein the one or more sensors include an arrayof proximity sensors embedded in the headrest adjacent the forehead restsurface.
 18. (canceled)
 19. The headrest of claim 10, wherein theheadrest is coupled to a joystick controller, the joystick controllercomprising: a first plate attached to the headrest; a sensor plate; anda controller coupled between the first plate and the sensor plate sothat motion of the headrest is detected.
 20. The headrest of claim 10,wherein the one or more sensors includes a slip plate mounted to thehead rest, the slip plate communicating with an optical detectorpositioned to detect motion of the slip plate, wherein the slip platepositioned to move with the surgeon's head.
 21. The headrest of claim10, wherein the one or more sensors includes a camera, the cameraproviding images of the surgeon's face below the forehead rest.
 22. Anendoscope control system, comprising: endoscope control that receives asignal that indicates movement of a surgeon's head and provides anindication of movement of an image received by an endoscope; endoscopemanipulation that receives the indication of movement of the image andgenerates a signal to affect movement of the endoscope to controlmovement of the image; and actuation that receives the signal to affectmovement of the endoscope and in response moves the endoscope.
 23. Theendoscope control system of claim 22, further comprising one or moresensors in a surgeon console headrest and configured to generate thesignal.
 24. The endoscope control system of claim 23, wherein the one ormore sensors includes a sensor chosen from a group of sensors consistingof a pressure sensor array, an array of proximity sensors, a joystickcontrol, a slip plate monitored by an optical detector, and a camera.25-28. (canceled)
 29. The endoscope control system of claim 23 furthercomprising one or more sensors associated with a surgeon's console. 30.The endoscope control system of claim 29, wherein the one or moresensors includes one or more cameras.
 31. The endoscope control systemof claim 29, wherein the one or more sensors includes one or more iristracking sensors.
 32. The endoscope of claim 22, further comprisingspeed of the movement of the image indicated to the surgeon.